Introduction to value-based insurance design.
When all patients are required to pay the same out-of-pocket amount for imaging services, which have varying degrees of benefit dependent on patient characteristics, there is potential for overuse and underuse. Rising costs of health care have stimulated efforts to redesign health care packages. Cost sharing has emerged, whereby costs are the same for everybody. Unlike traditional health care plan designs, value-based insurance design tailors the cost of care delivery to the benefit that a patient or class of patients derives from that care. With value-based insurance design, cost sharing is still used, but a "clinically sensitive" approach is designed to mitigate the adverse health consequences of high out-of-pocket costs. The authors summarize the principles of value-based insurance design and review examples of its implementation in other areas of medicine.
Kelly
Aine Marie
AM
Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-5302, USA. ainekell@med.umich.edu
Cronin
Paul
P
Carlos
Ruth C
RC
D017047:Cost Sharing / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000191:economics; D035082:Federal Government; D005102:Health Expenditures; D006801:Humans; D007342:Insurance Benefits / Q000191:economics*; D007345:Insurance Claim Review; D007348:Insurance, Health / Q000191:economics*; D009310:National Health Insurance, United States / Q000191:economics*; D009936:Organizational Innovation; D017149:Private Sector; D014481:United States; D019472:Universal Health Insurance / Q000191:economics*